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Blunted hypothalamic-pituitary-adrenal axis and insulin response to psychosocial stress in young adults born preterm at very low birth weight

Authors

  • Nina Kaseva,

    Corresponding author
    1. Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
    • Correspondence: Nina Kaseva, Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland. Tel.: +358 400 837526; Fax: +358 29 5248661; E-mail: nina.kaseva@fimnet.fi

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  • Karoliina Wehkalampi,

    1. Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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  • Riikka Pyhälä,

    1. Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
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  • Elena Moltchanova,

    1. Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Department of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
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  • Kimmo Feldt,

    1. Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
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  • Anu-Katriina Pesonen,

    1. Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
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  • Kati Heinonen,

    1. Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
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  • Petteri Hovi,

    1. Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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  • Anna-Liisa Järvenpää,

    1. Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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  • Sture Andersson,

    1. Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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  • Johan G. Eriksson,

    1. Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
    3. Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
    4. Vasa Central Hospital, Vasa, Finland
    5. Folkhälsan Research Centre, Helsinki, Finland
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  • Katri Räikkönen,

    1. Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
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  • Eero Kajantie

    1. Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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Summary

Background

Young adults born preterm at very low birth weight (VLBW, ≤1500 g) have higher levels of cardiovascular risk factors, including impaired glucose regulation, than their term-born peers. This could be mediated through altered hypothalamic-pituitary-adrenal axis (HPAA) response to stress.

Objective

To compare HPAA, glucose and insulin responses provoked by psychosocial stress in VLBW subjects versus a comparison group of term-born controls.

Design and participants

We studied 54 unimpaired young adults, aged 19–27 years, born at VLBW and a comparison group of 40 adults born at term, group-matched for age, sex and birth hospital, from one regional centre in southern Finland. The participants underwent a standardized psychosocial stress test (Trier Social Stress Test, TSST).

Measurements

In conjunction with TSST, we measured salivary cortisol, plasma ACTH, cortisol, glucose and insulin. Data were analysed with mixed-effects model and multiple linear regression analyses.

Results

Baseline concentrations for cortisol, ACTH, insulin and glucose were similar in VLBW and comparison groups. During TSST, analysed with mixed-effects model, overall concentrations of plasma cortisol were 17·2% lower (95% CI; 3·5 to 28·9) in the VLBW group. The VLBW group also had lower salivary (P = 0·04) and plasma cortisol (P = 0·02) responses to TSST. Insulin and glucose concentrations correlated with changes in cortisol concentrations. Accordingly, VLBW subjects had 26·5% lower increment in insulin (95% CI; 9·8–40·1). Analyses were adjusted for age, sex, body mass index, hormonal contraception, menstrual cycle phase, time of day and parental education.

Conclusions

VLBW adults have lower HPAA responses to psychosocial stress than term-born controls. This is accompanied by a lower insulin response.

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